Wiener klinische Wochenschrift

, Volume 122, Issue 13–14, pp 397–404 | Cite as

The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study

  • Tomislav Ćabov
  • Darko Macan
  • Ino Husedžinović
  • Jasenka Škrlin-Šubić
  • Danica Bošnjak
  • Sandra Šestan-Crnek
  • Berislav Perić
  • Zoran Kovač
  • Vesna Golubović
Original article

Summary

OBJECTIVES: To evaluate the impact of oral health on the evolution of nosocomial infections and to document the effects of oral antiseptic decontamination on oral health and on the rate of nosocomial infections in patients in a surgical intensive-care unit (ICU). DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Surgical ICU in University Hospital Dubrava. PATIENTS: The study included 60 nonedentulous patients consecutively admitted to the surgical ICU and requiring a minimum stay of three days. MAIN OUTCOME MEASURES: After randomization, the treatment group underwent antiseptic decontamination of dental plaque and the oral mucosa with chlorhexidine gel. The control group was treated with placebo gel. Dental status was assessed using a caries-absent-occluded (CAO) score, and the amount of plaque was assessed using a semi-quantitative score. Samples of dental plaque, oral mucosa and nasal and tracheal aspirates were collected for bacterial culture, and nosocomial infections were assessed. RESULTS: The plaque score significantly increased in the control group and decreased in the treated patients. Patients who developed a nosocomial infection had higher plaque scores on admission and during their ICU stay. The control group showed increased colonization by aerobic pathogens throughout their ICU stay and developed nosocomial infections (26.7%) significantly more often than the treated patients (6.7%); the control group also stayed longer in the ICU (5.1 ± 1.6 vs. 6.8 ± 3.5 days, P = 0.019). Furthermore, a trend in reduction of mortality was noted in the treated group (3.3% vs. 10%). CONCLUSIONS: Among surgical ICU patients, poor oral health had a significant positive correlation with bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU stay, and mortality in these patients.

Keywords

Nosocomial infection Dental plaque Oral decontamination Chlorhexidine Intensive-care patients 

Einfluss von Mundgesundheit und von 0,2 % Chlorhexidin-Gel auf die Entwicklung von nosokomialen Infektionen bei Patienten auf einer chirurgischen Intensivstation

Zusammenfassung

ZIEL: Erfassung der Bedeutung der Mundgesundheit auf die Entwicklung von nosokomialen Infektionen, sowie Dokumentation der Wirkungen oraler antiseptischer Dekontamination auf die Rate nosokomialer Infektionen von Patienten auf einer chirurgischen Intensivstation (ICU). STUDIENDESIGN: Prospektiv, randomisiert, doppelblind, Placebo-kontrolliert. SETTING: Chirurgische ICU eines Universitätsspitals (Dubrava). PATIENTEN: Die Studie umfasste 60 Patienten ohne künstliches Gebiss, die konsekutiv auf der chirurgischen ICU für mindestens drei Tage aufgenommen waren. METHODIK: Nach Randomisierung wurde eine antiseptische Dekontamination der Zähne und der Mundschleimhaut mit Chlorhexidin-Gel in der Behandlungsgruppe durchgeführt. Die Kontrollgruppe wurde mit Placebo-Gel behandelt. Der Zahnstatus wurde mittels eines "Caries-absent-occluded" (CAO) Scores und eines semiquantitativen Scores zur mengenmäßigen Erfassung der Zahn-Plaques erhoben. Abstriche für Bakterien-Kulturen aus den Zahn-Plaques, der Mundschleimhaut, und der Aspirate aus Nase und Trachea wurden zur Erfassung von nosokomialen Infektionen durchgeführt. ERGEBNISSE: In der Kontrollgruppe war der Plaque-Index-Level signifikant im Vergleich zur behandelten Gruppe erhöht. Patienten, die eine nosokomiale Infektion entwickelten, hatten einen höheren Plaque-Index bei Aufnahme und während ihres Aufenthaltes an der ICU. Bei der Kontrollgruppe wurde ein erhöhter Befall mit aeroben Keimen während des Aufenthaltes an der ICU beobachtet. Die Kontrollgruppe entwickelte signifikant häufiger (26,7 %) nosokomiale Infektionen als die behandelte Gruppe (6,7 %). Auch ihr Aufenthalt an der ICU war signifikant länger (5,1 ± 1,6 vs. 6,8 ± 3,5 Tage, P = 0,019). Außerdem wurde in der behandelten Gruppe ein Trend zu einer reduzierten Mortalität beobachtet (3,3 vs. 10 %). SCHLUSSFOLGERUNGEN: Eine schlechte Mundgesundheit war signifikant positiv mit bakterieller Besiedlung und der Entwicklung von nosokomialen Infektionen korreliert. Eine orale Dekontamination mit Chlorhexidin senkte die oropharyngeale Besiedlungsrate, sowie die Inzidenz nosokomialer Infektionen ebenso wie die Dauer des Aufenthaltes an der ICU und die Sterblichkeit von Patienten einer chirurgischen ICU signifikant.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tomislav Ćabov
    • 1
  • Darko Macan
    • 2
  • Ino Husedžinović
    • 3
  • Jasenka Škrlin-Šubić
    • 4
  • Danica Bošnjak
    • 3
  • Sandra Šestan-Crnek
    • 4
  • Berislav Perić
    • 2
  • Zoran Kovač
    • 5
  • Vesna Golubović
    • 6
  1. 1.Department of Oral and Maxillofacial SurgerySchool of Medicine, University of RijekaRijekaCroatia
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital Dubrava, School of Dental Medicine, University of ZagrebZagrebCroatia
  3. 3.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Dubrava, School of Dental Medicine, University of ZagrebZagrebCroatia
  4. 4.Department of Clinical Microbiology and Hospital InfectionsUniversity Hospital Dubrava, Zagreb; School of Medicine, University of RijekaRijekaCroatia
  5. 5.Department of DentistryClinical Hospital Center RijekaRijekaCroatia
  6. 6.Department of Anesthesiology and Intensive Care MedicineSchool of Medicine, University of RijekaRijekaCroatia

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